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CPR feedback devices during training

Question Type:
Intervention
Full Question:
Among students who are taking basic life support or advanced life support  courses in an educational setting (P), does CPR feedback device use (I), compared with no use of CPR feedback devices (C), change improve patient outcomes, skill performance in actual resuscitations, skill performance at 1 year, skill performance at course conclusion, cognitive knowledge (O)?
Consensus on Science:
For the critical outcomes of improvement of patient outcomes and skill performance at actual resuscitation, we found no evidence that examined the use of feedback devices. For the important outcome of skill performance at 1 year, we found 3 studies (low-quality evidence downgraded for imprecision, inconsistency, and risk of bias) that retested subjects after a period of time (6 weeks to 12 months) and showed substantial decay in skills irrespective of whether a feedback device was used.(Spooner 2007, 417; Mpotos 2011, 896; Oermann 2011, 447) Meta-analysis was not possible. For the important outcome of skill performance at course conclusion, we found 28 low-quality studies (downgraded for risk of bias, imprecision, and indirectness) that demonstrated some limited improvement in CPR quality.(Elding 1998, 169; Wik 2001, 167; Handley 2003, 57; Perkins 2005, 103; Williamson 2005, 140; Noordergraaf 2006, 241; Beckers 2007, 100; Spooner 2007, 417; Sutton 2007, 161; Dine 2008, 2817; Isbye 2008, 73; Oh 2008, 273; Rawlins 2009, b4707; Skorning 2010, 53; Fischer 2011, 902; Mpotos 2011, 896; Oermann 2011, 447; Skorning 2011, 717; Sutton 2011, e116; Woollard 2012, 290; Dold 2014, 245; Khanal 2014, 49; Park 2014, 153; Yeung 2014, 553; Zapletal 2014, 560; Cheng 2015, 137) Compression depth, compression rate, chest recoil, hand placement, hands-off time, and ventilation were used as markers of CPR quality. Heterogeneous reporting prevented some meta-analyses. There were 23 directive feedback studies(Elding 1998, 169; Wik 2001, 167; Handley 2003, 57; Perkins 2005, 103; Williamson 2005, 140; Noordergraaf 2006, 241; Beckers 2007, 100; Spooner 2007, 417; Dine 2008, 2817; Isbye 2008, 73; Skorning 2010, 53; Fischer 2011, 902; Mpotos 2011, 896; Oermann 2011, 447; Skorning 2011, 717; Sutton 2011, e116; Mpotos 2013, 72; Khanal 2014, 49; Park 2014, 153; Yeung 2014, 553; Zapletal 2014, 560; Cheng 2015, 137) showing that in comparison with no feedback devices, the use of feedback devices • Had no effect on mean depth (SMD, −0.10; 95% CI, −0.58 to 0.39; P=0.70). • Increased the number of participants able to compress to the correct depth (OR, 3.47; 95% CI, 2.55–4.73; P
Treatment Recommendation:
We suggest the use of feedback devices that provide directive feedback on compression rate, depth, release, and hand position during training (weak recommendation, low-quality evidence). If feedback devices are not available, we suggest the use of tonal guidance (examples include music or metronome) during training to improve compression rate only (weak recommendation, low-quality evidence). Values, Preferences, and Task Force Insights Unfortunately, several of the tonal studies identified compression depth decreasing as the participant focused on the rate. The positive effect of real-time feedback devices on CPR performance was found only at the end of training. In making these recommendations, a higher value was placed on the potential of improving CPR performance over the potential costs. Used by BLS instructors, these real-time feedback adjuncts can provide accurate participant performance information to give effective feedback during training.(Dine 2008, 2817) Real-time directive feedback devices provide immediate feedback on performance, including depth, rate, hand placement, and release. Guidance feedback devices are tonal devices that only prompt rate.
CoSTR Attachments:
Should corrective CPR feedback device vs. no device be used for BLS-ALS training-.pdf    
Should guidance performance feedback devices vs. No device be used in BLS and ALS training-.pdf    
Should Tonal-Music guidence vs. No guidence be used for BLS-ALS training-.pdf    

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